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Mandatory Filing Requirements

Governmental Self-Insured Employers are required to file important legible and complete information on an annual basis with the Division of Workers’ Compensation. A self-insurer is responsible for being aware of these obligations and their corresponding due dates. Florida statutes and rules specify the required information that must be provided, the form it must be provided on, and when the form is due. Self-insurers that do not file their information timely are subject to penalties (Rule  69L-5.217, F.A.C.). Please review the forms and filing requirements below:

Mandatory Filing Requirements Checklists

Active Governmental Self-Insured Employers (Checklist)

Former Governmental Self-Insured Employers (Checklist)

Mailing Address:

Self-Insurance Unit
Division of Workers’ Compensation
Florida Department of Financial Services
200 East Gaines Street
Tallahassee, Florida 32399

Contact Us:

Ingrid Passetti
Telephone Number: (850) 413-1828